FHIR rapidly advancing as healthcare data exchange standard

Health Level Seven International’s Fast Healthcare Interoperability Resources (FHIR) application programming interface is making significant progress on the road to becoming a mature standard, with the normative version slated for release early next year.

According to HL7’s CEO Chuck Jaffe, MD, the normative version of FHIR will be “backward-compatible with all the existing trial use standards and will be stable enough for large vendors to incorporate into their platforms.”

Until then, he said HL7 will continue to refine the draft standard for exchanging healthcare information that is seen as a promising solution to the complex challenges of health IT interoperability facing the industry.

Chuck Jaffe, MD

“One of the really critical things that has been baked into the FHIR platform is a maturity model, so at any given time you know the level of maturity of a resource,” Jaffe told an audience this week at the WEDI national conference in Salt Lake City.

In September 2015, HL7 published Release 2 of the FHIR Draft Standard for Trial Use (DSTU), the culmination of 18 months of extensive work to incorporate changes received from implementation partners. Those suggestions also included those from private sector-led Argonaut Project, whose goal is to accelerate current development efforts to provide the industry with practical and focused FHIR profiles and implementation guides.

The Argonaut Project, a group of providers and health IT vendors, has been working since late 2014 to test the interoperability of FHIR profiles and implementations. Phase One of the group’s efforts focused on both data and document queries within the enterprise, while Phase Two focused on security for cross-enterprise authentication.

“Phase Two was an important part of the Argonaut Project because it for the first time enabled inter-system interoperability,” said Jaffe, noting that it incorporated OAuth2 and OpenID technologies that supported authentication and authorization for systems in different healthcare environments to communicate reliably with one another.

In addition, he said Phase Two of the Argonaut Project was structured into a series of testing “sprints” conducted by participating organizations in concentrated two- and three-week intervals that resulted in a new approach for reducing the development cycle. “Instead of being on a cycle like HL7 every three or four months, it was built on short sprints,” according to Jaffe, who added that Argonaut Project Phase Three is currently ongoing and has scheduled similar sprints over the next few months.

Jaffe is encouraged by the fact that when providers were recently asked in a KLAS survey which standards, organizations, associations or collaborations will provide the highest future value to national interoperability, HL7’s FHIR ranked number one. “Currently, we’re off the charts with expectations.” However, he is quick to point out that “a standard is not used because we created it; it is a standard because people use it.”

Working in its favor, Jaffe said that FHIR is free to use and embed within products and services and is licensed without royalty, just like other HL7 standards. “We can’t make this happen if people refuse to put data in a format that can be consumed,” he concluded. “But, certainly we can create an environment and ecosystem to support it.”

Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, believes that FHIR-based services will ultimately be implemented on top of commercial electronic health record systems.

“We ought to be willing to pay the vendors a reasonable cost for doing that because it’s work on their part to implement those services,” added Huff. “Hopefully, we can convince them that it’s better for everyone, including them, to program to the standards. So far, they’ve bought into FHIR pretty well. I’ve never seen this much excitement about a particular technology as I’ve seen around FHIR.”

Under the Argonaut Project, five EHR vendors—athenahealth, Cerner, eClinicalWorks, Epic and MEDITECH—are implementing the Substitutable Medical Applications and Reusable Technologies (SMART), which leverages FHIR in their next product releases. SMART is also being adopted across several major health systems, including Boston Children’s Hospital, Duke Health and Geisinger Health System, which are implementing SMART on FHIR apps on top of their EHR systems.